by Lisa Baertlein

Volunteer firefighter Cindy Holland has no medical insurance, and her husband's health benefits as a full-time paramedic do not extend to family members, so she and their three children go without.

The hard-working Northern California family makes too much money to qualify for public health insurance but too little to afford a private policy, caught in a Catch 22 that puts many U.S. workers at risk of financial ruin.

While many industrialized countries provide care for all, the United States covers only the elderly and the poor. Some 45 million, or 15 percent, of people in the world's richest nation lacked health insurance in 2005, up 3 percent on the previous year.

That number is widely believed to be higher today as healthcare costs skyrocket, employers slash worker benefits and insurers gut coverage and cherry-pick the healthiest customers.

President George W. Bush and governors of states like California have taken on the task of finding ways to provide health coverage, but it's not soon enough for families like the Hollands.

'ROLLING THE DICE'

John Holland, like most Americans, gets his health insurance through his job as a paramedic with a private ambulance company, which pays half the expense.

When Cindy, 36, shopped for coverage for herself and their children, she found it would cost about $1,000 a month, excluding dental insurance.

"It would kill us financially to do the insurance -- if we want to keep a roof over our head and food in my kids. You end up rolling the dice," said Cindy, a California native who works a pair of part-time jobs on top of firefighting.

As a two-parent family, the Hollands could earn just over $60,000 and still be eligible for Healthy Families, a children's health insurance program financed by state and federal funds.

But that would require John to stop working overtime, which he does in order to pay old medical bills and other expenses.

Meanwhile, Cindy wrestles with the idea of applying for public benefits.

"I wasn't raised to do that," she said. "It's almost embarrassing that you're not covered. There is this stereotype that you're an illegal alien sitting on your butt and not working."

These days, the family heads to one of the many Wal-Mart in-store health clinics springing up around the country, where doctor visits cost $39.

"We went from one extreme to the other," said Cindy, who when she was pregnant with triplets had good insurance through John's prior job. Surgery and follow-up care to save the lives of two of them -- one died in the womb -- cost just $200.

THE BIG SQUEEZE

More and more, America's uninsured -- and increasingly its insured population -- can't win. And the prospects are grim as U.S. healthcare spending is projected to double to $4 trillion by 2015.

Mexico-born Maria Morales, 53, is a single mom and legal U.S. resident who is a full-time caregiver to her severely disabled son. They are both covered under public programs.

Lately, though, she worries about her 16-year-old, a U.S. citizen who suffers from fainting and dizzy spells and was mistakenly cut from public coverage.

It took her nine months and help from Los Angeles' Venice Family Clinic, the nation's largest free clinic, to get him reinstated. Meanwhile, a recommended trip to the neurologist had to be delayed.

"I find myself with a big surprise that life is so hard in the United States. I'm a resident, just imagine how difficult it is for people who are undocumented," she said.

Jeremy Smola, 33, already knows the devastating toll an illness can take on people living in what many immigrants see as a "Land of Opportunity."

Five years ago, he had no insurance and was diagnosed with a goiter. He finally had it removed three years later, when he had a job with health benefits.

Even with insurance coverage, Smola had $15,000 in uncovered medical bills. He declared bankruptcy, and, like about half of the people who do, cited medical expenses as a key reason.

After years of pursuing a music career, Smola plans to join the "real work force" and find a job with benefits.

"I'm at an age where if I start a family, you have to have it. You can lose everything if you break a leg and can't work for six months," said Smola, who performed with the unsightly goiter on his neck as he searched for a job with benefits.

Jonathan Cohn, author of the new book "Sick" about the broken U.S. healthcare system, said America's wasteful and inadequate safety net is eroding at a rapid pace, but thinks improvement is possible.

"Most people have a sense that an enlightened society does not do this to its citizens," Cohn said. "We've solved this for the elderly (with Medicare). Every other country in the developed world has solved this."
Copyright © 2007 Reuters Limited.